PROJECT SUMMARY/ABSTRACT Morbidity and mortality rates from type 2 diabetes (T2D) are high and continue to increase, with only 14% of adults who have T2D meeting targets for glycosylated hemoglobin (A1c). Immigrants and racial/ethnic groups have worse rates of achieving the target A1c goal. Self-management is critical in meeting glycemic control. Haitian immigrants have unique migration experiences compared to other ethnic groups that may impact their T2D self-management. Our preliminary work reveals differences in Haitian immigrants dietary and exercise habits compared with their practices in Haiti. Haitian immigrants also have higher A1c levels compared with African Americans and Cuban Americans. The purpose of this application is to characterize self-management behaviors, barriers to T2D self-management, and glycemic control in adult Haitian immigrants. Our aim is to reduce health care disparities by developing a T2D self-management education intervention specific to adult Haitian immigrants. Data from the K99 phase will inform the development of a diabetes self-management education (DSME) program to be carried out during the R00 phase and establish feasibility, acceptability, and preliminary efficacy. Our aims are to: 1) Describe self-management behaviors of 100 adult Haitian immigrants with T2D as measured by multiple methods (diabetes self-management survey, 3-day diet recall, blood glucose level, physical activity via accelerometer, and pill counts) and their correlations with glycemic biomarkers (A1c and continuous glucose variability via continuous glucose monitoring (CGM); 2) Describe barriers to self-management in these 100 adult Haitian immigrants with T2D including socio-demographic status, health status (comorbidity), psychosocial factors (cultural health beliefs, acculturative and discrimination stress), and environmental factors (access to care, food insecurity) using mixed methods (quantitative surveys and interviews with a subsample); 3) Use community-engaged approaches with 10 adult Haitian immigrants with T2D to develop a DSME program to reduce barriers and improve self-management and glycemic control; and 4) Conduct a randomized pilot study with 60 adult Haitian immigrants to establish feasibility, acceptability, and preliminary efficacy of the DSME program compared to standard care. We will use descriptive approaches for the K99 and aim 3 of the R00 phase. For aim 4, we will use a randomized pilot study design. A hip actigraphy measures of physical activity, glycemic biomarkers from A1c and glucose variability via CGM, self- report, objective, and interview measures of self-management will be collected. Data will be analyzed using multiple regression, content analysis techniques, and preliminary effect sizes will be generated from aim 4. The project is significant in its potential to enhance understanding of T2D self-management and glycemic control in this immigrant population at high-risk for negative T2D health outcomes. This study addresses NINR?s key theme, ?Self-Management of Chronic Conditions?. The accomplished mentor committee and the candidate?s ongoing research relationships in this field will create the ideal setting for these investigations.